JP6833849B2 - Treatment tool - Google Patents

Description

The present invention relates to a treatment tool.

Conventionally, there are known treatment tools for treating (joining (or anastomosing) and dissecting) a living tissue by applying energy to the living tissue (see, for example, Patent Document 1).
The treatment tool (thermal coagulation incision forceps) described in Patent Document 1 has a second jaw that grips a living tissue between a first jaw (first grip portion) having a first grip surface and the first grip surface. It is provided with a second jaw (second grip portion) having a grip surface. Further, the first jaw is provided with a heating element that generates heat when energized and heats the first gripping surface. Then, in the treatment tool, the living tissue is treated by grasping the living tissue with the first and second jaws and heating the living tissue by the heat generated by the heating element (giving heat energy to the living tissue). ..

Japanese Patent No. 3349139

By the way, when the treatment using thermal energy is performed, the heat transferred to the living tissue gradually spreads radially around the heat source (heating element). For this reason, in the tissue to be treated that is gripped by the first and second jaws of the living tissue, it takes time for heat to be transferred in the thickness direction (grasping direction), and it is difficult to shorten the treatment time. There is. In addition, if it takes a sufficient time for heat to be transferred in the thickness direction, the heat spreads radially around the heat source (heating element), so that the heat spreads radially to the surrounding tissues around the tissue to be treated in the living tissue. Heat energy acts up to, which may interfere with minimally invasive treatment.

The present invention has been made in view of the above, and an object of the present invention is to provide a treatment tool capable of shortening the treatment time and performing treatment with minimal invasiveness.

In order to solve the above-mentioned problems and achieve the object, the treatment tool according to the present invention has a second grip that grips a living tissue between a first jaw having a first grip surface and the first grip surface. A second electrode having a surface, a first electrode provided on the first gripping surface, a second electrode provided on the first gripping surface and to which high-frequency power is supplied between the first electrode, and the above. A heating element provided in the second jaw different from the jaw provided with the first electrode and the second electrode and generating heat by energization is provided, and the first electrode and the second electrode are held in the first grip. When the surfaces face each other along the width direction of the first gripping surface and the first gripping surface and the second gripping surface are opposed to each other and viewed along the facing directions. It is arranged at each position sandwiching the center position of the heating element.

According to the treatment tool according to the present invention, the treatment time can be shortened and the treatment can be performed with minimal invasiveness.

FIG. 1 is a diagram showing a treatment system according to the first embodiment of the present invention. FIG. 2 is a diagram showing the grip portion shown in FIG. FIG. 3 is a diagram showing the grip portion shown in FIG. FIG. 4 is a diagram showing the positional relationship between the first and second electrodes shown in FIGS. 2 and 3 and the thermal energy applying portion. FIG. 5A is a diagram illustrating the effect of the first embodiment of the present invention. FIG. 5B is a diagram illustrating the effect of the first embodiment of the present invention. FIG. 5C is a diagram illustrating the effect of the first embodiment of the present invention. FIG. 6 is a diagram showing a grip portion constituting the treatment tool according to the second embodiment of the present invention. FIG. 7 is a diagram showing a grip portion constituting the treatment tool according to the third embodiment of the present invention. FIG. 8 is a diagram showing a grip portion constituting the treatment tool according to the fourth embodiment of the present invention.

Hereinafter, embodiments for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Further, in the description of the drawings, the same parts are designated by the same reference numerals.

(Embodiment 1)
[Outline configuration of treatment system]
FIG. 1 is a diagram showing a treatment system 1 according to a first embodiment of the present invention.
The treatment system 1 treats (joins (or anastomoses), dissects, etc.) the living tissue by applying energy (thermal energy and electrical energy (high frequency energy)) to the living tissue. As shown in FIG. 1, the treatment system 1 includes a treatment tool 2, a control device 3, and a foot switch 4.

[Structure of treatment tool]
The treatment tool 2 is, for example, a linear type surgical treatment tool for treating a living tissue through the abdominal wall. As shown in FIG. 1, the treatment tool 2 includes a handle 5, a shaft 6, and a grip portion 7.
The handle 5 is a portion where the operator holds the treatment tool 2 by hand. The handle 5 is provided with an operation knob 51 as shown in FIG.
As shown in FIG. 1, the shaft 6 has a substantially cylindrical shape, and one end (the right end portion in FIG. 1) is connected to the handle 5. A grip portion 7 is attached to the other end of the shaft 6 (the left end portion in FIG. 1). An opening / closing mechanism (not shown) for opening / closing a pair of jaws 8 and 9 (FIG. 1) constituting the grip portion 7 is provided inside the shaft 6 in response to an operation of the operation knob 51 by an operator. ing. Further, inside the shaft 6, an electric cable C (FIG. 1) connected to the control device 3 is passed from one end side (right end side in FIG. 1) to the other end side (in FIG. 1) via a handle 5. It is arranged up to the left end side).

[Structure of grip]
2 and 3 are views showing the grip portion 7. Specifically, FIG. 2 is a perspective view showing a grip portion 7 set in an open state (a state in which a pair of jaws 8 and 9 are opened (separated)). FIG. 3 shows a grip portion 7 set in a closed state in which the biological tissue LT is gripped (a pair of jaws 8 and 9 are closed (a pair of grip surfaces 81 and 91 face each other)). It is a cross-sectional view cut along the width direction (the width direction (the left-right direction in FIGS. 2 and 3) orthogonal to the longitudinal direction connecting the tip end and the base end of the grip portion 7).
The grip portion 7 is a portion that grips the biological tissue LT (FIG. 3) and treats the biological tissue LT. As shown in FIGS. 1 to 3, the grip portion 7 includes a pair of jaws 8 and 9.
The pair of jaws 8 and 9 are pivotally supported at the other end of the shaft 6 so as to be openable and closable in the direction of arrow R1 (FIG. 2), and the living tissue LT can be gripped according to the operation of the operation knob 51 by the operator.

[Joe composition]
One of the pair of jaws 8 and 9 is arranged on the upper side of the other jaw 9 in FIGS. 2 and 3, and has a length connecting the tip end and the base end of the one jaw 8. It has a substantially rectangular parallelepiped shape extending along the direction. The material of the jaw 8 on the other hand is a material having high heat resistance, low thermal conductivity, and excellent electrical insulation, for example, PTFE (polytetrafluoroethylene) and PEEK (polyetheretherether). Resins such as ketone) and PBI (polybenzimidazole) can be exemplified. The material of one of the jaws 8 is not limited to the resin, and ceramics such as alumina and zirconia may be used. Further, PTFE, DLC (Diamond-Like Carbon), ceramic-based, silica-based, or silicone-based insulating coating materials having non-adhesiveness to living organisms may be attached to them.
Then, in FIGS. 2 and 3 of one jaw 8, the lower surface functions as a gripping surface 81 for gripping the biological tissue LT with the other jaw 9. In the following, the gripping surface 81 will be referred to as one gripping surface 81, and the gripping surface 91 will be referred to as the other gripping surface 91 in order to distinguish it from the gripping surface 91 of the other jaw 9, which will be described later.

In the first embodiment, one gripping surface 81 is formed to be flat.
The one grip surface 81 is located on both end sides in the width direction (the left and right end sides in FIGS. 2 and 3), and the total length of the one grip surface 81 (total length in the longitudinal direction, hereinafter the same). As shown in FIG. 2 or 3, the first and second electrodes 10 and 11, respectively, are embedded in the region extending over.
The first and second electrodes 10 and 11 are each made of a conductive material such as copper, aluminum, or carbon. Further, the first and second electrodes 10 and 11 are each composed of a substantially rectangular parallelepiped plate body extending along the longitudinal direction of one gripping surface 81, and one plate surface (lower side in FIGS. 2 and 3). Surface) is embedded in the one grip surface 81 so as to form a part of one grip surface 81 (with the lower surface exposed). Further, a pair of high frequency lead wires (not shown) constituting the electric cable C arranged from one end side to the other end side of the shaft 6 are joined to the first and second electrodes 10 and 11, respectively. .. Then, the first and second electrodes 10 and 11 can generate high frequency energy by supplying high frequency power by the control device 3 via the pair of high frequency lead wires. When high-frequency power is supplied while the biological tissue LT is gripped by the pair of jaws 8 and 9 (pair of gripping surfaces 81 and 91), a high-frequency potential is generated between the first and second electrodes 10 and 11. Therefore, a high frequency current can be passed through the living tissue LT. That is, the first and second electrodes 10 and 11 are a pair of electrodes in which one is a positive electrode and the other is a negative electrode.
The first and second electrodes 10 and 11 are not limited to the plate body, but are different from a round bar or the like which is embedded with a convex portion smaller than the distance between the pair of jaws 8 and 9. The shape does not matter. Further, the first and second electrodes 10 and 11 do not have to be bulk materials, and may be made of a conductive thin film such as platinum formed by vapor deposition, sputtering or the like. Further, the surfaces of the first and second electrodes 10 and 11 are not limited to the physical exposure as described above, but may be electrically exposed. That is, even if a conductive coating material such as a Ni-PTFE film or a conductive DLC (Diamond-Like Carbon) thin film having non-adhesiveness to a living body is attached, the surface provides a potential as an electrode. It does not deviate from the intent of the invention.

The other jaw 9 has a substantially rectangular parallelepiped shape extending along the longitudinal direction connecting the tip end and the proximal end of the other jaw 9. As the material of the other jaw 9, similarly to the one jaw 8, resins such as PTFE, PEEK and PBI, ceramics such as alumina and zirconia can be exemplified.
Then, in FIGS. 2 and 3 of the other jaw 9, the upper surface functions as the other grip surface 91 that grips the biological tissue LT with the one grip surface 81.

In the first embodiment, the other gripping surface 91 is formed to be flat like the one gripping surface 81.
In the other gripping surface 91, the region located in the central portion in the width direction (the central portion in the left-right direction in FIGS. 2 and 3) and extending over the entire length of the other gripping surface 91 is in FIG. 2 or FIG. As shown in the above, the thermal energy applying portion 12 is embedded.
As shown in FIG. 2 or 3, the heat energy applying unit 12 includes a heating element 121 (FIG. 3) and a heat transfer member 122.
The heating element 121 extends from the base end side (right side in FIG. 2) of the other jaw 9 to the tip end side (left side in FIG. 2) along the longitudinal direction, and further bends to the base end side. It is composed of an electric resistance pattern having an extending substantially U-shape. Further, a pair of heat generating lead wires (not shown) forming an electric cable C arranged from one end side to the other end side of the shaft 6 are joined to both ends of the heating element 121. Then, the heating element 121 generates heat when a DC or AC voltage is applied (energized) by the control device 3 via the heat generating lead wire.

The heating element 121 described above is made by processing stainless steel (SUS304), which is a conductive material, and is attached to the central portion of the heat transfer member 122 in the width direction on the lower surface in FIG. 3 by thermocompression bonding. ing.
The material of the heating element 121 is not limited to stainless steel (SUS304), and other stainless steel materials (for example, No. 400 series) may be used, or a conductive material such as platinum or tungsten may be used. Further, the heating element 121 is not limited to a configuration in which the heat transfer member 122 is bonded to the lower surface of the heat transfer member 122 by thermocompression bonding, but a configuration formed by vapor deposition, sputtering, or the like is adopted on the lower surface. It doesn't matter.

The heat transfer member 122 has a material having high heat resistance, high thermal conductivity, and excellent electrical insulation, for example, a resin such as PTFE, PEEK, PBI, and ceramic as a heat conductive filler. It is composed of the contained composite material, ceramic such as aluminum nitride, and a material in which an insulating coating such as PTFE is applied to a conductive substance such as copper, aluminum, and carbon. Further, the heat transfer member 122 is composed of a substantially rectangular parallelepiped plate extending along the longitudinal direction of the other gripping surface 91, and in FIGS. 2 and 3, the upper surface is a part of the other gripping surface 91. (With the upper surface exposed), it is embedded in the other gripping surface 91. Then, the heat transfer member 122 transfers the heat from the heating element 121 to the living tissue LT (provides heat energy to the living tissue LT).
The heat transfer member 122 has a pair of jaws 8 and 9 having separate bodies (lower heat transfer member and upper heat transfer member) having different sizes in the width direction (upper and lower in FIGS. 2 and 3). A configuration in which high heat transfer is bonded in the direction) may be used. For example, as the heating element 121, a ceramic heater in which a conductive thin film is formed on the lower heat transfer member by sputtering, and the ceramic heater are bonded to the upper heat transfer member by high heat transfer bonding such as nano-Ag particles. That is, the lower heat transfer member and the upper heat transfer member may be collectively considered as the heat transfer member 122.
An insulating coating material having the above-mentioned non-adhesiveness to a living body may be attached to the other gripping surface 91 described above.

In the first embodiment, one jaw 8 corresponds to the first jaw according to the present invention. Further, one gripping surface 81 corresponds to the first gripping surface according to the present invention. Further, the other jaw 9 corresponds to the second jaw according to the present invention. The other gripping surface 91 corresponds to the second gripping surface according to the present invention.

[Positional relationship between the 1st and 2nd electrodes and the heat energy applying part]
FIG. 4 is a diagram showing the positional relationship between the first and second electrodes 10 and 11 and the thermal energy applying portion 12. Specifically, FIG. 4 shows the first and first positions along the facing directions (normal directions of the pair of gripping surfaces 81 and 91) in a closed state (a state in which the pair of gripping surfaces 81 and 91 face each other). It is the figure which looked at 2 electrodes 10, 11 and the thermal energy addition part 12.
As shown in FIG. 4, the first and second electrodes 10 and 11 are in the width direction of the heat energy applying portion 12 when the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other in the closed state. It is arranged at each position sandwiching the central position O1. More specifically, the center position O2 in the width direction of the first and second electrodes 10 and 11 is set to coincide with the center position O1 of the thermal energy applying portion 12. Further, the first and second electrodes 10 and 11 are arranged outside the heating element 121 in the width direction, respectively.

[Control device and foot switch configuration]
The foot switch 4 is a part operated by the operator with his / her foot. Then, in response to the operation of the foot switch 4, the control device 3 switches the energization of the treatment tool 2 (first and second electrodes 10, 11 and the heating element 121) on and off.
The means for switching on and off is not limited to the foot switch 4, and a hand-operated switch or the like may be adopted.
The control device 3 includes a CPU (Central Processing Unit) and the like, and comprehensively controls the operation of the treatment tool 2 according to a predetermined control program. More specifically, the control device 3 is placed between the first and second electrodes 10 and 11 via a pair of high-frequency lead wires in response to an operation on the foot switch 4 by the operator (operation of turning on the power). Along with supplying high-frequency power of a preset output, power of a preset output is applied to the heating element 121 via a pair of heat generating lead wires at a preset timing, and the respective energies are appropriately controlled.

[Operation of treatment system]
Next, the operation of the above-mentioned treatment system 1 will be described.
The operator holds the treatment tool 2 by hand and inserts the tip portion (a part of the grip portion 7 and the shaft 6) of the treatment tool 2 into the abdominal cavity through the abdominal wall using, for example, a trocca. Further, the operator operates the operation knob 51 and grips the biological tissue LT with a pair of jaws 8 and 9.
Next, the operator operates the foot switch 4 to switch the energization from the control device 3 to the treatment tool 2 on. When switched on, the control device 3 supplies high-frequency power between the first and second electrodes 10 and 11 via a pair of high-frequency lead wires. Along with the supply of the high-frequency power, a high-frequency current flows between the first and second electrodes 10 and 11, and Joule heat is applied to the tissue to be treated LT1 (FIG. 3) between the first and second electrodes 10 and 11 in the living tissue LT. Occurs. Further, the control device 3 applies (energizes) electric power to the heating element 121 via a pair of heat generating lead wires at the same time as supplying the high frequency electric power. Along with the energization, the heating element 121 generates heat, and the heat is transferred to the tissue to be treated LT1 via the heat transfer member 122. Then, the tissue to be treated LT1 is treated by the generation of the Joule heat and the heat transfer from the heat transfer member 122.
The timing of supplying high-frequency power to the first and second electrodes 10 and 11 and the timing of applying (energizing) the power to the heating element 121 are not limited to the same time, and may be different timings.

According to the first embodiment described above, the following effects are obtained.
5A to 5C are diagrams illustrating the effect of the first embodiment of the present invention. Specifically, FIG. 5A is a diagram showing the results of simulation, in which the heating element 121 is maintained at a preset temperature without supplying high-frequency power between the first and second electrodes 10 and 11. It is a figure which shows the temperature distribution in (when only heat energy was applied to biological tissue LT). FIG. 5B is a diagram showing the results of the simulation, in which high-frequency power of a preset output is supplied between the first and second electrodes 10 and 11 without generating heat of the heating element 121 (living tissue LT). It is a figure which shows the temperature distribution in the case where only high frequency energy was applied to. FIG. 5C is a diagram showing the results of simulation, in which high-frequency power of a preset output is supplied between the first and second electrodes 10 and 11, and power of a preset output is applied to the heating element 121. It is a figure which shows the temperature distribution in the case of (when both thermal energy and high frequency energy are applied to biological tissue LT).
In FIGS. 5A to 5C, a region having a high temperature is shown as it approaches "black", and a region having a low temperature is shown as it approaches "white". That is, in FIGS. 5A to 5C, it is shown that the temperature of the lighter color is lower and the temperature of the darker color is higher.
Further, FIGS. 5A and 5C show the temperature distribution at the moment when one of the gripping surfaces 81 without the thermal energy applying portion 12 reaches a desired temperature (about 200 ° C.).

When the treatment using thermal energy is performed, the heat transferred to the living tissue LT gradually spreads radially around the heat source (heating element 121) according to the thermal conductivity of the material. Therefore, in the tissue to be treated LT1, there is a problem that it takes time for heat to be transferred in the thickness direction (grip direction (vertical direction in FIGS. 3 and 5A to 5C), hereinafter the same).
Then, as a simulation result of "when only thermal energy is applied to the living tissue LT", the central portion in the width direction of one of the gripping surfaces 81 after the start of applying the thermal energy is at a desired temperature (200 ° C.). The result was that it took T1 seconds (about 2.4 seconds) to reach the degree) (FIG. 5A). Further, after T1 second, the thermal energy applying portion 12 is continuously touched for T1 second, and the peripheral tissue around the tissue to be treated LT1 also becomes a relatively high temperature. (Fig. 5A).

When the treatment using high frequency energy is performed, the high frequency current flows between the first and second electrodes 10 and 11. Then, if the first and second electrodes 10 and 11 are arranged at positions facing each other along the width direction of one of the gripping surfaces 81 as in the first embodiment, the high frequency current can be generated by a pair of jaws. It flows in the width direction of 8 and 9 (in the left and right directions in FIGS. 3 and 5A to 5C). That is, since the portion where the high-frequency current flows between the first and second electrodes 10 and 11 can be used as the heat generating portion, the tissue to be treated LT1 is closer to the center in the width direction of the pair of jaws 8 and 9 (first and first). It can be limited to (between 2 electrodes 10 and 11). Further, in the tissue to be treated LT1, the portion separated from the pair of gripping surfaces 81 and 91 in the thickness direction can be set to the highest temperature. However, the impedance of the tissue to be treated LT1 increases as the drying (dehydration) of the tissue to be treated LT1 starts in response to the application of high frequency energy, and as a result, the action of the high frequency energy weakens at a certain time, which is desired. May not be possible. The "sometimes" include "when the power supply capacity cannot follow the increase in impedance" and "the amount of heat generated by these does not exceed the amount of heat lost by transpiration or heat transfer, and can contribute to the rise in tissue temperature. "When it disappears" can be illustrated.
Then, as a simulation result of "when only high frequency energy is applied to the living tissue LT", the treatment target tissue LT1 is limited to the center of the pair of jaws 8 and 9 in the width direction, and the treatment target tissue LT1 The result is that the portion separated from the pair of gripping surfaces 81 and 91 in the thickness direction has the highest temperature (FIG. 5B). However, the maximum temperature reached of the tissue to be treated LT1 does not reach the desired temperature (about 200 ° C.) even after T1 second (about 2.4 seconds) has passed since the application of high-frequency energy was started (maximum). The simulation result was that the ultimate temperature was about 150 ° C. (Fig. 5B).

In the case of performing the treatment using both the thermal energy and the high frequency energy as in the first embodiment, the simulation result of "when both the thermal energy and the high frequency energy are applied to the living tissue LT" (FIG. As shown in 5C), each of the above-mentioned problems can be solved.
That is, since the application of high-frequency energy produces an assist effect for the application of thermal energy, the central portion in the width direction of one of the gripping surfaces 81 is desired after the application of both thermal energy and high-frequency energy is started. The time to reach the temperature (about 200 ° C.) is nearly 60% shorter than the time (T1 second) in "when only thermal energy is applied to the living tissue LT" (T2 seconds (1.5)). The result was about seconds)). Further, since the short time of T2 seconds, it is sufficient to keep touching the heat energy applying portion 12 for T2 seconds, and the influence of heat on the peripheral tissues around the tissue to be treated LT1 is reduced, so that the peripheral tissues are reduced. The result of the simulation was that the temperature was relatively low.
Therefore, according to the treatment tool 2 according to the first embodiment, the treatment time can be shortened and the treatment can be performed with minimal invasiveness. Further, since the total amount of heat of the materials forming the pair of jaws 8 and 9 is small, the effect of reducing the temperature of the pair of jaws 8 and 9 after the treatment is completed is also obtained.
It is also known that the maximum temperature reached by the living tissue LT can be improved by the living tissue LT and the applied energy conditions, and the temperature reached by the heating element 121 can be reduced, so that the reliability of the heating element 121 can be reduced. It also contributes to improvement.

In particular, in the treatment tool 2 according to the first embodiment, the widths of the first and second electrodes 10 and 11 in the heating element 121 when the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other. It is arranged at each position sandwiching the center position O1 in the direction. More specifically, the center position O2 in the width direction of the first and second electrodes 10 and 11 coincides with the center position O1. That is, the heat generation region due to the application of high frequency energy and the heat generation region due to the application of thermal energy can be overlapped. Therefore, it is possible to enhance the above-mentioned assist effect and preferably realize the above-mentioned effect that "the treatment time can be shortened and the treatment can be performed with minimal invasiveness".
Further, in the treatment tool 2 according to the first embodiment, the first and second electrodes 10 and 11 refer to the heating element 121 when the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other. And are arranged on the outside in the width direction. In other words, the heating element 121 is arranged closer to the center in the width direction on the other gripping surface 91. Therefore, the influence of thermal energy on the surrounding tissue around the tissue to be treated LT1 can be further reduced.

By the way, when the first and second electrodes 10 and 11 and the thermal energy applying portion 12 are provided on one of the pair of jaws 8 and 9 (when they are provided on the same jaw), the following problems may occur. is there.
When the tissue around the first and second electrodes 10 and 11 is dried (dehydrated) due to the application of thermal energy from the thermal energy applying unit 12 to the biological tissue LT, and the impedance of the tissue is increased, the first The action of high-frequency energy by the first and second electrodes 10 and 11 is weakened. That is, the above-mentioned assist effect may be reduced.
In the treatment tool 2 according to the first embodiment, the first and second electrodes 10 and 11 and the heat energy applying portion 12 are provided on different jaws. Therefore, there is no possibility that the above-mentioned problem will occur. Specifically, the high-frequency power avoids the tissue whose impedance has increased due to the action of the thermal energy imparting unit 12, and is selectively applied to the untreated living tissue LT having a low impedance, so that the treatment is assisted more effectively. Can be done.

(Embodiment 2)
Next, Embodiment 2 of the present invention will be described.
In the description of the second embodiment, the same reference numerals are given to the same configurations as those of the first embodiment described above, and the detailed description thereof will be omitted or simplified.
FIG. 6 is a diagram showing a grip portion 7A constituting the treatment tool 2A according to the second embodiment of the present invention. Specifically, FIG. 6 is a cross-sectional view corresponding to FIG.
In the treatment tool 2A according to the second embodiment, as shown in FIG. 6, with respect to the treatment tool 2 (FIG. 3) described in the above-described first embodiment, the first and second electrodes according to the present invention are used. The placement position is different.

In one jaw 8 according to the second embodiment, the first and second electrodes 10 and 11 are not provided on the one gripping surface 81 as shown in FIG. The one gripping surface 81 according to the second embodiment is not provided with the first and second electrodes 10 and 11, but has a flat shape as in the first embodiment described above. An insulating coating material having non-adhesiveness to the living body described in the above-described first embodiment may be attached to the one gripping surface 81.
Further, in the other jaw 9 according to the second embodiment, as shown in FIG. 6, the other gripping surface 91 is provided with the first and second electrodes 10A and 11A in addition to the thermal energy applying portion 12. ing.

The first and second electrodes 10A and 11A impart high-frequency energy to the living tissue LT (treatment target tissue LT1) having the same shape and function as the first and second electrodes 10 and 11 described in the first embodiment described above. Has a function to do).
These first and second electrodes 10A and 11A are located at both ends in the width direction (both sides of the thermal energy applying portion 12) on the other gripping surface 91, and are embedded in the region over the entire length of the other gripping surface 91, respectively. ing. The first and second electrodes 10A and 11A form a part of the other gripping surface 91, respectively. The other gripping surface 91 according to the second embodiment has the first and second electrodes 10A and 11A embedded therein, but has a flat shape as in the first embodiment described above. In the other gripping surface 91, the region composed of the upper surface in FIGS. 6 of the first and second electrodes 10A and 11A has the non-adhesiveness to the living body described in the above-described first embodiment. A conductive coating material is applied, and the other regions (the regions of the heat transfer member 122 composed of the upper surface in FIG. 6) are non-adhesive to the living body described in the above-described first embodiment. An insulating coating material may be attached.
Here, in the second embodiment, when the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other in the closed state, the first and second electrodes 10A and 11A and the thermal energy applying portion 12 The positional relationship is the same as that of the first embodiment described above.
The first and second electrodes 10A and 11A are not limited to the plate body, but are different from a round bar or the like which has a convex portion smaller than the distance between the pair of jaws 8 and 9 and is embedded. The shape does not matter. Further, the first and second electrodes 10A and 11A do not have to be bulk materials, and may be made of a conductive thin film such as platinum formed by vapor deposition, sputtering or the like.

In the second embodiment, the other jaw 9 corresponds to the first jaw according to the present invention. The other gripping surface 91 corresponds to the first gripping surface according to the present invention. Further, one jaw 8 corresponds to the second jaw according to the present invention. Further, one gripping surface 81 corresponds to the second gripping surface according to the present invention.

According to the treatment tool 2A according to the second embodiment described above, the same effect as that of the first embodiment described above is obtained.
Further, in the treatment tool 2A according to the second embodiment, the other jaw 9 is provided with the first and second electrodes 10A and 11A and the thermal energy applying portion 12. In other words, one of the jaws 8 is not provided with any of the first and second electrodes 10A and 11A and the thermal energy applying portion 12. Therefore, the structure of one jaw 8 can be simplified, and the one jaw 8 can be miniaturized (the diameter of the grip portion 7A is reduced).

(Embodiment 3)
Next, Embodiment 3 of the present invention will be described.
In the description of the third embodiment, the same reference numerals are given to the same configurations as those of the first embodiment described above, and the detailed description thereof will be omitted or simplified.
FIG. 7 is a diagram showing a grip portion 7B constituting the treatment tool 2B according to the third embodiment of the present invention. Specifically, FIG. 7 is a diagram corresponding to FIG.
In the treatment tool 2B according to the third embodiment, as shown in FIG. 7, with respect to the treatment tool 2 (FIG. 3) described in the above-described first embodiment, the first and second electrodes according to the present invention are used. The arrangement position and the forming method are different.

In one jaw 8 according to the third embodiment, as shown in FIG. 7, the one gripping surface 81 is provided with the first and second electrodes 10 and 11 as in the second embodiment described above. It does not have a flat shape. Further, an insulating coating material having non-adhesiveness to the living body described in the above-described first embodiment may be attached to the one gripping surface 81.
Further, in the other jaw 9 according to the third embodiment, as shown in FIG. 7, the other gripping surface 91 is provided with the first and second electrodes 10B and 11B in addition to the thermal energy applying portion 12. ing.

The first and second electrodes 10B and 11B have the same functions as the first and second electrodes 10 and 11 described in the first embodiment described above (a function of imparting high frequency energy to the biological tissue LT (treatment target tissue LT1). ), But its arrangement position and formation method are different.
Specifically, the first and second electrodes 10B and 11B are each composed of a conductive thin film such as platinum formed by vapor deposition, sputtering or the like. Further, as shown in FIG. 7, the first and second electrodes 10B and 11B are located at both ends in the width direction on the upper surface of the heat transfer member 122 in FIG. 7, and have the overall length of the heat transfer member 122. It is formed in each of the extending regions. The first and second electrodes 10B and 11B form a part of the other gripping surface 91, respectively. The other gripping surface 91 according to the third embodiment has the first and second electrodes 10B and 11B, respectively, but has a flat shape as in the first embodiment described above. On the other gripping surface 91, the region composed of the first and second electrodes 10B and 11B is provided with a conductive coating material having non-adhesiveness to the living body described in the first embodiment described above. An insulating coating material having non-adhesiveness to the living body described in the first embodiment may be attached to the other regions.
That is, in the third embodiment, since the first and second electrodes 10B and 11B are formed on the heat transfer member 122, they are arranged at each position on the other gripping surface 91 separated from the outer edge in the width direction. ing. Further, in the third embodiment, when the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other in the closed state, the first and second electrodes 10B, as in the first embodiment described above, The center position in the width direction in 11B and the center position in the width direction in the thermal energy applying portion 12 coincide with each other.
The first and second electrodes 10B and 11B are not limited to the thin film, and may be made of a bulk material like the first and second electrodes 10 and 11 described in the first embodiment described above. Absent.

In the third embodiment, the other jaw 9 corresponds to the first jaw according to the present invention. The other gripping surface 91 corresponds to the first gripping surface according to the present invention. Further, one jaw 8 corresponds to the second jaw according to the present invention. Further, one gripping surface 81 corresponds to the second gripping surface according to the present invention.

According to the treatment tool 2B according to the third embodiment described above, the same effects as those of the first and second embodiments described above can be obtained.
Further, in the treatment tool 2B according to the third embodiment, the first and second electrodes 10B and 11B are arranged at positions separated from the outer edge in the width direction on the other gripping surface 91, respectively. That is, by reducing the separation dimension in the width direction of the first and second electrodes 10B and 11B, the treatment target tissue LT1 located between the first and second electrodes 10B and 11B has the width of the pair of jaws 8 and 9. It can be further limited to the center of the direction. Therefore, the influence of heat on the surrounding tissue around the tissue to be treated LT1 can be further reduced.

By the way, the path of the high-frequency current flowing between the first and second electrodes 10B and 11B is changed with the passage of time due to the increase in the impedance of the biological tissue LT due to the application of high-frequency energy. Specifically, when the first and second electrodes 10B and 11B are provided on the other gripping surface 91 as in the third embodiment, the other gripping surface 91 is immediately after starting the application of high frequency energy. A high-frequency current flows along a path close to the surface 91. Then, after starting the application of high-frequency energy, a high-frequency current flows along a path close to one of the gripping surfaces 81 with the passage of time. That is, the path of the high-frequency current changes with the passage of time along the thickness direction of the tissue to be treated LT1.
In particular, when the separation dimension in the width direction of the first and second electrodes 10B and 11B is reduced as in the third embodiment, the high-frequency current path is relatively along the thickness direction of the tissue to be treated LT1. Will be changed in a short time. Therefore, the above-mentioned assist effect can be further enhanced, and the above-mentioned effect of "reducing the treatment time and performing the treatment with minimal invasiveness" can be suitably realized.

(Embodiment 4)
Next, Embodiment 4 of the present invention will be described.
In the description of the fourth embodiment, the same reference numerals are given to the same configurations as those of the first embodiment described above, and the detailed description thereof will be omitted or simplified.
FIG. 8 is a diagram showing a grip portion 7C constituting the treatment tool 2C according to the fourth embodiment of the present invention. Specifically, FIG. 8 is a diagram corresponding to FIG.
In the treatment tool 2C according to the fourth embodiment, as shown in FIG. 8, with respect to the treatment tool 2 (FIG. 3) described in the above-described first embodiment, the first and second gripping surfaces according to the present invention. The shape of is different.

In one jaw 8 according to the fourth embodiment, the first and second electrodes 10C and 11C and the insulating member 13 are provided on the one gripping surface 81 as shown in FIG.
The first and second electrodes 10C and 11C have the same functions as the first and second electrodes 10 and 11 described in the first embodiment described above (a function of imparting high frequency energy to the biological tissue LT (treatment target tissue LT1). ), But the arrangement position is different.
Specifically, as shown in FIG. 8, the first and second electrodes 10C and 11C are located at positions separated from the outer edge in the width direction of one gripping surface 81, and cover the entire length of the one gripping surface 81. It is embedded in each. Further, the first and second electrodes 10C and 11C are embedded in a state of protruding from one jaw 8 toward the other jaw 9, respectively. Then, in FIG. 8 of the first and second electrodes 10C and 11C, the lower surface constitutes one gripping surface 81, respectively.

The insulating member 13 is made of a material having high heat resistance, low thermal conductivity, and excellent electrical insulation, for example, a resin such as PTFE, PEEK, or PBI, or a ceramic such as alumina or zirconia. It is configured. Further, the insulating member 13 is composed of a substantially rectangular parallelepiped plate body extending along the longitudinal direction of one grip surface 81, and is located between the first and second electrodes 10C and 11C on one grip surface 81. , It is embedded in the area extending the entire length of the one gripping surface 81. Further, the insulating member 13 has one jaw 8 to the other so that the lower surface in FIG. 8 is flush with the lower surface in FIG. 8 of the first and second electrodes 10C and 11C. Each is embedded in a state of protruding toward the jaw 9. Then, in FIG. 8 of the insulating member 13, the lower surface constitutes one gripping surface 81, respectively.
That is, one of the gripping surfaces 81 according to the fourth embodiment is located at the center in the width direction, and is located on each of the lower surfaces of the first and second electrodes 10C and 11C and the insulating member 13 in FIG. The first central region Ar1 (FIG. 8) to be formed has a convex shape protruding toward the other jaw 9. On the one gripping surface 81, a conductive coating material having non-adhesiveness to the living body described in the above-described first embodiment is attached to the region composed of the first and second electrodes 10C and 11C. An insulating coating material having non-adhesiveness to the living body described in the first embodiment may be attached to the other regions.
The first and second electrodes 10C and 11C do not have to be bulk materials, and may be made of a conductive thin film such as platinum formed by vapor deposition or sputtering.

As shown in FIG. 8, the thermal energy applying portion 12 according to the fourth embodiment is embedded in a state of protruding from the other jaw 9 toward one jaw 8.
That is, the other gripping surface 91 according to the fourth embodiment is located at the center in the width direction, and is the second central region Ar2 (FIG. 8) formed by the upper surface of the heat transfer member 122 in FIG. ) Has a convex shape protruding toward one jaw 8. An insulating coating material having non-adhesiveness to the living body described in the above-described first embodiment may be attached to the other gripping surface 91.
The first and second central regions Ar1 and Ar2 described above have the same planar shape and face each other in a closed state.

In the fourth embodiment, when the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other in the closed state, the first and second electrodes 10C, as in the first embodiment described above, The center position in the width direction in 11C and the center position in the width direction in the thermal energy applying portion 12 coincide with each other.

In the fourth embodiment, one jaw 8 corresponds to the first jaw according to the present invention. Further, one gripping surface 81 corresponds to the first gripping surface according to the present invention. Further, the other jaw 9 corresponds to the second jaw according to the present invention. The other gripping surface 91 corresponds to the second gripping surface according to the present invention.

According to the treatment tool 2C according to the fourth embodiment described above, the same effect as that of the first embodiment described above is obtained.
Further, in the treatment tool 2C according to the fourth embodiment, the pair of gripping surfaces 81 and 91 each have the first and second central regions Ar1 and Ar2, and each has a convex shape. The first and second electrodes 10C and 11C are provided in the first central region Ar1. Further, a thermal energy applying portion 12 is provided in the second central region Ar2. Therefore, the tissue LT1 to be treated can be compressed with a high pressure, and the tissue LT1 to be treated can be effectively treated (joining, anastomosis, sealing, etc.).

(Other embodiments)
Although the embodiments for carrying out the present invention have been described so far, the present invention should not be limited only to the above-described embodiments 1 to 4.
In the above-described first to fourth embodiments, the pair of gripping surfaces 81 and 91 are formed of a flat surface or a convex shape, but the present invention is not limited to this, and other shapes may be used. For example, in order to effectively incise the biological tissue LT, at least one of the pair of gripping surfaces 81, 91 may have a V-shaped cross section in which the portion corresponding to the incision position is close to the other gripping surface. ..

In the above-described first to fourth embodiments, two electrodes, the first electrode 10 (10A to 10C) and the second electrode 11 (11A to 11C), are provided in order to apply high frequency energy, but the number of electrodes Is not limited to two, and three or more may be provided .

In the above-described embodiments 1 to 4, the arrangement positions of the first electrodes 10 (10A to 10C), the second electrodes 11 (11A to 11C), and the thermal energy applying portion 12 are arranged in the above-described embodiments 1 to 4. It is not limited to the arrangement position explained in. When the pair of gripping surfaces 81 and 91 are viewed along the directions facing each other, the first electrode 10 (10A to 10C) and the second electrode are located at each position of the thermal energy applying portion 12 with the center position O1 in the width direction sandwiched. As long as 11 (11A to 11C) is arranged, other arrangement positions may be adopted. For example, in the above-described first to fourth embodiments, the first electrodes 10 (10A to 10C) and the second electrodes 11 (11A to 11C) are provided on one of the pair of gripping surfaces 81 and 91. (Although it was provided on the same gripping surface), a configuration provided on different gripping surfaces may be adopted.

In the fourth embodiment described above, both of the pair of gripping surfaces 81 and 91 have a convex shape, but the present invention is not limited to this, and for example, one of the pair of gripping surfaces 81 and 91 is formed flat. The other may be configured to have a convex shape, or one of the pair of gripping surfaces 81, 91 may be formed to have a convex shape and the other may have a concave shape.

In the above-described embodiments 1 to 4, the treatment tools 2 (2A to 2C) are configured to apply thermal energy and high frequency energy to the biological tissue LT for treatment, but the present invention is not limited to this. In addition to thermal energy and high-frequency energy, LT may be treated by applying optical energy such as ultrasonic energy and laser.

1 Treatment system 2, 2A to 2C Treatment tool 3 Control device 4 Foot switch 5 Handle 6 Shaft 7, 7A to 7C Grip part 8, 9 Joe 10, 10A to 10C 1st electrode 11, 11A to 11C 2nd electrode 12 Thermal energy Grant part 13 Insulating member 51 Operation knob 81, 91 Grip surface 121 Heating element 122 Heat transfer member Ar1, Ar2 1st, 2nd central area C Electric cable LT Living tissue LT1 Treatment target tissue O1, O2 Center position R1 Arrow

Claims (7)

A first jaw having a first gripping surface and
A second jaw having a second gripping surface that grips the biological tissue between the first gripping surface and the
The first electrode provided on the first gripping surface and
A second electrode provided on the first gripping surface and to which high-frequency power is supplied between the first electrode and the first electrode.
A heating element provided in the second jaw different from the jaw provided with the first electrode and the second electrode and generating heat by energization is provided.
The first electrode and the second electrode face each other on the first gripping surface along the width direction of the first gripping surface, and the first gripping surface and the second gripping surface face each other. A treatment tool that is arranged at each position that sandwiches the center position of the heating element when viewed along the opposite direction in the state of being moved. When the first electrode and the second electrode are viewed along the facing directions in a state where the first gripping surface and the second gripping surface are opposed to each other, the first electrode and the second electrode are viewed with respect to the heating element. The treatment tool according to claim 1, which is arranged outside the first gripping surface and the second gripping surface in the width direction, respectively. Wherein the first electrode and the second electrode, the treatment instrument according to claim 1 or 2 are arranged to each position separated from the outer edge of the first gripping surface. The first electrode and the second electrode have a shape extending along the longitudinal direction of the first gripping surface, and the center positions of these electrodes are such that the first gripping surface and the second gripping surface face each other. The treatment tool according to any one of claims 1 to 3, which matches the center position of the heating element when viewed along the opposite direction in the state of being moved. The first gripping surface has a first central region located at the center in the width direction.
The second gripping surface is located in the center in the width direction and has a second central region facing the first central region.
At least one of the first gripping surface and the second gripping surface has a convex shape in which at least one of the first central region and the second central region protrudes toward the other.
The first electrode is provided in the first central region and is provided.
The treatment tool according to any one of claims 1 to 4, wherein the second electrode is provided in one of the first central region and the second central region. The second gripping surface is provided with a heat transfer member for transferring heat from the heating element to the biological tissue, and the heat transfer member has high thermal conductivity and electrical insulation, claims 1 to 5. The treatment tool according to any one of. The invention according to any one of claims 1 to 6 , wherein an insulating member having low thermal conductivity and electrical insulation is provided between the first electrode and the second electrode on the first gripping surface. Treatment tool.